Provider Demographics
NPI:1801804182
Name:MIDLAND ORAL SURGERY AND IMPLANT CENTERS, LTD
Entity type:Organization
Organization Name:MIDLAND ORAL SURGERY AND IMPLANT CENTERS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-429-4770
Mailing Address - Street 1:7625 159TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1492
Mailing Address - Country:US
Mailing Address - Phone:708-429-4770
Mailing Address - Fax:708-429-9685
Practice Address - Street 1:7625 159TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1492
Practice Address - Country:US
Practice Address - Phone:708-429-4770
Practice Address - Fax:708-429-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty